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Margot Kushel MD Profile picture
@MKushel
Dec 19, 2019 • 6 tweets • 4 min read • Read on X
Role of racism in perpetuating homelessness in late life: new #HOPEHOME qual study led by @dereckpaul Black Americans 3-4x ⬆️ risk homelessness. Key take homes: 1) It's racism, not race (1/x) tandfonline.com/eprint/XYYVVPJ…
1. experiences of early life overt racism create risk 2. Structural racism throughout life course (i.e. criminal justice & employment discrimination, exposure to violence, premature death, and limited family wealth) ⬆️ & perpetuate risk 2/x
Themes came through voices & experience of participants. Of note, only 1 non-Black participant mentioned race--in context of how her white race brought privilege in crim justice system. Many Black ppts spoke re: stories, but few/none named structural racism-bc effects 3/x
bc that is how structural racism works. Take homes: 1) we cannot discuss homelessness w/o understanding role interpersonal (incl early life) & structural racism plays. 2) racial disparities d/t racism, not race! 3) solutions need to be anti-racist. Gratitude to @dereckwpaul 4/x
#JohnWeeks, #PamOlsen, @PubHealthCityPl @kellyrayknight & #HOPEHOME ppts who told story and Community Advisory Board who guided. @UCSF @ucsfcvp
@dereckwpaul

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More from @MKushel

Margot Kushel MD Profile picture
Mar 25, 2022
Housing First works. We have tons of evidence to support it. The problem is--we don't have the housing. The soln: we need to preserve, protect, produce housing for the lowest income renters. Happy to talk to @BigadShaban @nbcbayarea about the evidence. 1/x
Discussed our eval study w @mravenEM @DSTNHome @SCCgov @abode_services @ucsfbhhi which showed that even the "hardest to house" ppl could be housed FOR YEARS w/o preconditions 2/x

hsr.org/node/664701
We gave Abode, SCC a list of the folks who were homeless who faced the most challenges (⬆️use of hospitals, ED, jail, psych, etc)--and randomly assigned folks to Housing First Permanent Supportive Housing w "intensive case management"--a master's trained counselor (e.g. LCSW) 3/x
Read 16 tweets
Margot Kushel MD Profile picture
Jul 14, 2021
A🧵about #COVID vaccines. The @ucsfbhhi has spent last several mos working w great partners to provide vax to folks in the Tenderloin--including those who are homeless/formerly homeless. After providing 2500+vax to folks who face many barriers to vaccines--some thoughts: 1/x Bright mural on wall, tree holding homes with inscription: E
We talk alot about vax "hesitancy" but--we found, access>>>hesitancy. We had small, local sites (@GLIDEsf & Boeddeker Park)--with great outreach/ no appts needed. Helpful for those who couldn't get to mass vax sites. Reached 100s of folx, but not enough: So, what worked? 2/X Sunny day, blue topped tends on city street with ppl in them
Mobile teams! Teams, led by the incredible @codetenderloin --ppl w deep roots in community, lived expertise--w MD/NP or RN & "scribe." Teams walked around neighborhood and vaccinated folks wherever we found them. We answered ?s, supported ppls' choices--& when ready--vaxxed 3/X Ppl. casually dressed, masks--cart with bright pink sign &qu
Read 9 tweets
Margot Kushel MD Profile picture
Oct 19, 2020
This policy change is v problematic. Don't be fooled by talk of ⬆️mental health. The reason homelessness has ⬆️ is bc the fundamental drivers of homelessness: income inequality, lack of deeply affordable ("ELI") housing & racism-- have worsened. A 🧵 1/x
bit.ly/3dF5Sdn
Housing First has a strong evidence base. Our recent study showed it successfully housed 86% of the "most difficult" to house chronically homeless ppl w high rates of substance use and mental health disabilities. hsr.org/node/664701 2/x
Read 12 tweets
Margot Kushel MD Profile picture
Sep 25, 2020
Our paper, RCT on PSH for the highest user of healthcare is out @HSR_HRET. PSH w/ intensive case management ends homelessness for 86% of the highest users of multiple services. A lot of subtlety here. A 🧵@mravenEM @ucsfcvp @ucsfbhhi @ucsf onlinelibrary.wiley.com/doi/full/10.11… 1/x
Multi-year RCT comparing PSH (subsidized housing, mostly scattered site; ICM 1:15 master’s trained led team by @abode_services) vs usual care for chronically homeless ppl who were highest users of acute healthcare/jail in @sccgov 423 participants (199 intervent/224 control). 2x
Inclusions: chronic homelessness; highest users of services. Ineligible: engagement other program, req nursing home, hospice eligible. We created risk score/triage tool to calculate highest users (mult criteria). Triage tool calculated continuously & flagged in records. 3/x
Read 20 tweets
Margot Kushel MD Profile picture
Jul 7, 2020
Thrilled to be listening to @nhannahjones & Marla Newman, Chair BOD @NLIHC on #RacialEquityAndCOVID from lens of housing/homelessness!
Image
& @nhannahjones spelling out how control of housing was mechanism of social control in North (racial covenants, redlining)."You don't have to pass laws saying Black ppl couldn't go to school with White ppl if you control where they live--& create neighborhood schools"
Read 26 tweets
Margot Kushel MD Profile picture
May 15, 2020
Must read editorial in @nytimes on #homelessness that lays out the problem, where blame lays, & solution--"The fed govt could render homelessness rare, brief & nonrecurring. The cure for homelessness is housing." (YES!) A thread 1/x @BCAppelbaum

nytimes.com/2020/05/15/opi…
1. Problem is housing (not individual vulnerabilities) 2. Federal govt (& realistically, only Fed) could solve it 3. Instead, feds heavily subsidize wealthy homeowners, instead of low-income (mortgage interest tax deduction means homeowners live in deeply subsidized housing) 2/x
4. We spend $12 Billion a yr on shelters (shelters are dangerous, difficult places (#COVID19 has made this more evident cdc.gov/mmwr/volumes/6… , but as CA Gov @GavinNewsom says: "shelters solve sleep, housing solves homelessness) & 1/3 (in CA 2/3) unsheltered) despite $12B 3/x
Read 12 tweets

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